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Busting the Myth on Headaches and Migraines

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Headache and migraine… such a common problem in our modern age. How often do you or someone you know suffer from a debilitating headache? In this post, Georgie Busse (one of our fantastic physios) takes headaches and migraines, breaks them down for you and busts the myth that you have to live with them.

How common is common?

Globally, it has been estimated that the prevalence of headaches among adults (symptomatic at least once a year) is about 50%. Half to three quarters of adults aged 18–65 years in the world have had a headache in the last year. Among those individuals, 30% or more have reported migraine.

Placing the pain in a category

Headaches are categorised into primary (originating in the head) and secondary (coming from somewhere else/another cause and referring to the head). A headache is any pain felt in the head… so a migraine is a TYPE of headache, but there are countless headache types. For simplicity, here are the 5 main categories:

  1. Migraine

    Migraine is recurrent, often life-long, and characterized by recurring attacks. Attacks are typically one-sided, of moderate or severe intensity, pulsating in quality, with duration of hours to 2-3 days and commonly associated nausea. Attack frequency is anywhere between once a year and once a week and in children, attacks tend to be of shorter duration and abdominal symptoms more prominent (more about this in a future newsletter!). Migraine most often begins at puberty and most affects those aged between 35 and 45 years. It is more common in women, usually by a factor of about 2:1, because of hormonal influences.headaches and migraines redness in eye

  2. Tension-type headache

    Tension-type headache is the most common type of headache. Attacks are typically both sides of the head, mild to moderate in intensity, described as pressure or tightness, often like a band around the head, sometimes spreading into or from the neck. Attacks can be episodic, occurring on fewer than 15 days per month OR chronic, occurring on more than 15 days per month.headaches and migraines vice 5

  3. Cluster Headache

    Cluster headache is relatively uncommon, affecting less than 1 in 1000 adults and more common in men, usually by a factor of 6:1. It is characterized by frequently recurring (up to several times a day), brief but extremely severe headache, usually focused in or around one eye, with tearing and redness of the eye, the nose runs or is blocked on the affected side and the eyelid may droop. Cluster headache has episodic and chronic forms (as per tension-type headache).

  4. Sinus Headache

    Sinus headaches occur due to congested sinuses. It usually feels like a buildup of pressure and pain behind the cheeks and forehead.

  5. Medication-overuse headache

    Medication-overuse headache is caused by chronic and excessive use of medication to treat headache. By definition it occurs on more days than not, is oppressive, persistent and often at its worst on awakening.

The “grey matter” on what causes headaches

Theory 1

Tension-Type Headache symptoms. This theory says that the small muscles around the scalp go into a form of ‘cramp’, causing the symptoms of tension/tightness in the head. Studies have shown that tension of the muscles in the forehead and scalp appeared no different in patients with tension-type headache when compared with headache-free patients. However, there has been a link to tension-type headache symptoms and increased tension in the neck muscles.

Theory 2

Migraine symptoms. This theory says that the blood vessels in the head dilate or expand, causing head pain. Studies have shown that the expansion of these blood vessels does not always coincide with the pain. It seems that they may dilate in response to pain in some people. Rather than being the consistent SOURCE of pain in all people.

Theory 3

The Convergence Theory. This theory suggests that the basis of all head pain may be a very sensitive brain! All the way back in 1888, a very clever and forward-thinking researcher said…

“…we must not ascribe too much significance to throbbing or the increase in pain to vascular distension; these may be due to the over sensitiveness of central structures…”

Well, 129 years later, it appears he may have been onto something.

Digging deeper into The Convergence Theory

Introducing Mr TCN

The part of the brain I’m referring to is in the lower brainstem, deep down inside the brain. More specifically, it’s a structure called the trigeminocervical nucleus. We’ll just call it the TCN for short. The TCN connects the nerves of the upper neck with the nerves around the face and head. When compared to a normal headache-free population, the TCN of a headache sufferer is extremely ‘edgy’… like a hypersensitive alarm system. If the TCN was a person (let’s call him Mr TCN, although ‘he’ could very easily be a ‘she’), he would be pacing around the room, in a state of severe irritation, giving you occasional violent outbursts over the slightest little thing. You really need to walk on eggshells around him.

headaches and migraines TCN simple

Effect of prescribed headache medication

Specific prescribed headache medications, used commonly by frequent headache sufferers, help to ‘chill out’ Mr TCN, so that his violent outbursts are quieted. They give good short term relief, but unfortunately Mr TCN remains in an underlying state of “mess with me and I’ll punch your lights out” mode, quite literally.

Scientifically, this ‘underlying state’ is called sensitisation of the lower brainstem, and specifically of the trigeminocervical nucleus or complex.

Current headache management

This aims to identify and cut out ‘triggers’ that send Mr TCN over the edge, like red wine, dairy, bright lights, too much physical activity, too much stress, too much noise and so on. As the list gets longer, life gets smaller.

headaches and migraines triggers

The more direct way is to ‘zonk out’ Mr TCN whenever he’s about to erupt, so that he stays in his little grumpy box. Unfortunately, these medications are fairly toxic and can zonk out other structures too. Consequently, they usually come with their own gamut of side effects.

headaches and migraines medication

A new approach

Why is Mr TCN so irritated anyway?! One of the reasons for Mr TCN’s edginess may be attributed to a barrage of ‘red alerts’ coming in from the structures of the upper neck. As stated earlier, Mr TCN connects the nerves of the upper neck and the nerves feeding the face and head.

Therefore, correcting dysfunction and postural issues around the upper neck can help to chill him out, so that he doesn’t ‘yell into the head’. By quelling the incoming pain signals from the neck, the proverbial ‘thorn in his side’, Mr TCN appears to be in a happier, less irritated space.

The Watson Technique

As mentioned above, for some, changing habits, correcting posture and reducing the tension in the neck muscles is all it takes to give that headache the boot. However, some headache sufferers have been pushed from pillar to post, drugged up and then drugged down, yet their symptoms remain. These people most likely need specific intervention.

There is a manual therapy program for the upper neck, taught by The Watson Headache Institute in Australia. This technique has been shown to effectively treat headaches, including migraines. The underlying mechanism of success is the ‘chilling out and shutting up’ of Mr TCN. When he is chilled out, he can give us all a little peace and quiet.

Georgie Busse has attended the 3 day Watson Headache® Institute, Level 1 Foundation Headache Course in Sydney, Australia presented by Dean H Watson, Australian Musculoskeletal Physiotherapist. She is now considered a Watson practitioner. With her new knowledge and skills, patients now have an even better chance of busting the myth of headaches and migraines.


World Health Organisation [Internet]. [Last updates April 2016; cited 23 April 2017]. WHO; Available on:

The International Headache Society [internet]. [Last updated 30.08.2016; cited 03 December 2016]. IHS; Available on:

Watson D, Drummond P (2012). Head pain referral during examination of the neck in migraine and tension-type headache. Headache, 54, 1035-1045.

Bartsch T, Goadsby P (2003). The trigeminocervical complex and migraine: Current concepts and synthesis. Current Pain and Headache Reports, 7, 371-376.

David M, Biondi D (2005). Physical treatments for Headache: A Structured Review. Headache, 45, 738-746.


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